外科医生的判断和经皮冠状动脉旁路移植术中即时传输时间流量探头的应用。

Surgeon judgment and utility of transit time flow probes in coronary artery bypass grafting surgery.

机构信息

Surgery Service, Veterans Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts.

Surgery Service, Charles George VA Medical Center, Asheville, North Carolina.

出版信息

JAMA Surg. 2014 Nov;149(11):1182-7. doi: 10.1001/jamasurg.2014.1891.

DOI:10.1001/jamasurg.2014.1891

PMID:25251332

Abstract

IMPORTANCE

Transit time flow (TTF) probes may be useful for predicting long-term graft patency and assessing grafts intraoperatively in patients undergoing coronary artery bypass grafting (CABG); however, studies of TTF probe use are limited.

OBJECTIVE

To examine 1-year graft patency and intraoperative revision rates in patients undergoing CABG based on intraoperative TTF assessment.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a multicenter randomized clinical trial conducted at 18 Veterans Affairs hospitals using the Randomized On/Off Bypass (ROOBY) Trial data set. Of the original 2203 patients undergoing CABG surgery with or without cardiopulmonary bypass from February 1, 2002, through May 31, 2008, we studied a subset of 1607 who underwent TTF probe analysis of 1 or more grafts during surgery.

EXPOSURES

Use of TTF probes to assess graft flow and pulsatility index (PI) values. The decision to revise a graft was based on the judgment of the attending surgeon.

MAIN OUTCOMES AND MEASURES

Rates of 1-year FitzGibbon grade A patency and intraoperative revision were compared based on TTF measurements (<20 [low flow] vs ≥20 mL/min [normal flow]) and PI values (<3, 3-5, and >5).

RESULTS

We measured TTF and/or PI in 2738 grafts, and 1-year patency was determined in 1710 (62.5%) of these grafts. FitzGibbon grade A patency occurred significantly less often in grafts with a TTF with low flow (259 of 363 [71.3%]) than in those with normal flow (1174 of 1347 [87.2%]; P < .01). FitzGibbon grade A patency was also inversely correlated with increasing PI values, as found in 936 of 1093 grafts (85.6%) with a PI less than 3, 136 of 182 grafts (74.7%) with a PI of 3 to 5, and 91 of 134 grafts (67.9%) with a PI greater than 5 (P ≤ .01). Intraoperative graft revision was more frequent in grafts with low flow (44 of 568 [7.7%]) than in those with normal flow (8 of 2170 [0.4%]; P < .01). Graft revision was also more frequent as PI increased (12 of 1827 [0.7%] with a PI <3, 9 of 307 [2.9%] with a PI 3-5, and 9 of 155 [5.8%] with a PI >5; P < .01).

CONCLUSIONS AND RELEVANCE

Intraoperative TTF probe data may be helpful in predicting long-term patency and in the decision of whether to revise a questionable graft for patients undergoing CABG surgery.

摘要

重要性

在接受冠状动脉旁路移植术（CABG）的患者中，瞬变时间流量（TTF）探头可能有助于预测长期通畅率并在术中评估移植物；然而，对 TTF 探头使用的研究是有限的。

目的

根据术中 TTF 评估，研究 CABG 患者的 1 年通畅率和术中再修复率。

设计、设置和参与者：对在 18 家退伍军人事务医院进行的多中心随机临床试验的回顾性分析，使用随机开/关旁路（ROOBY）试验数据集。在 2002 年 2 月 1 日至 2008 年 5 月 31 日期间接受 CABG 手术的 2203 例患者中，我们研究了其中的一个亚组 1607 例，这些患者在手术期间对 1 个或多个移植物进行了 TTF 探头分析。

暴露

使用 TTF 探头评估移植物的流量和搏动指数（PI）值。对移植物进行修订的决定基于主治外科医生的判断。

主要结果和测量

根据 TTF 测量值（<20[低流量]与≥20 mL/min[正常流量]）和 PI 值（<3、3-5 和>5），比较了 1 年菲茨吉本 A 级通畅率和术中再修复率。

结果

我们测量了 2738 个移植物的 TTF 和/或 PI，在这些移植物中，1710 个（62.5%）确定了 1 年的通畅率。低流量 TTF 组（259 个/363 个[71.3%]）的菲茨吉本 A 级通畅率明显低于正常流量 TTF 组（1174 个/1347 个[87.2%]；P<0.01）。菲茨吉本 A 级通畅率也与 PI 值的升高呈负相关，在 1093 个移植物中有 936 个（85.6%）PI 值<3，182 个移植物中有 136 个（74.7%）PI 值为 3 到 5，134 个移植物中有 91 个（67.9%）PI 值>5（P≤0.01）。低流量（44/568 [7.7%]）的移植物术中再修复率高于正常流量（8/2170 [0.4%]；P<0.01）。PI 值增加时，移植物再修复率也更高（PI<3 时有 12/1827 [0.7%]，PI 为 3-5 时有 9/307 [2.9%]，PI 为 5 时有 9/155 [5.8%]；P<0.01）。